Care and Support for Hepatocellular Cancer in India

Hepatocellular cancer treatment in India

Treatment Options for Hepatocellular Carcinoma:

Surgery

Liver Resection (Hepatectomy):

• Removal of the tumor-bearing part of the liver. Suitable for patients with good liver function (no significant cirrhosis or portal hypertension).

Liver Transplantation:

• Best for patients with poor liver function (cirrhosis, portal hypertension) or multiple small tumors. It eliminates the tumor and diseased liver.

Ablation Therapies (for patients not eligible for surgery)

• Radiofrequency Ablation (RFA): This is the use of heat to kill cancer cells.
• Microwave Ablation (MWA): This method is the same as RFA except that microwaves are used.
• Cryoablation: Freezes cancer cells.
• Ethanol Injection: Alcohol is used to inject into the tumor and kill cancer cells (less common now).

Embolization Therapies

Transarterial Chemoembolization (TACE):

• Pushes chemotherapy directly into the blood supply of the liver tumor and blocks the artery to starve the tumor.

Transarterial Radioembolization (TARE / SIRT):

• Involves the use of radioactive microspheres in destroying cancer cells within the tumor.

Targeted Therapy

• Sorafenib, Lenvatinib: The initial group of targeted drugs which inhibit the development of tumor blood vessels and cellular signaling of cancer cells.
• Regorafenib, Cabozantinib, Ramucirumab: Second-line targeted therapies.

Immunotherapy

Checkpoint Inhibitors:

• Atezolizumab + Bevacizumab (first-line combination).
• In some cases, nivolumab, pembrolizumab, durvalumab, and tremelimumab can be applied.
• These assist the immune system to attack liver cancer cells.

Radiation Therapy

• Stereotactic Body Radiotherapy (SBRT): High dose radiation to tumors.
• Applied in case of inoperable or ablutory surgery or ablation.

Systemic Chemotherapy

• The effectiveness of traditional chemotherapy (such as doxorubicin) is rarely effective and is normally used as a last resort when other treatments fail.

Best hospitals for hepatocellular carcinoma in India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Factors Affecting Hepatocellular cancer surgery cost in India

Following is the systematic guide to the main aspects that determine the cost of hepatocellular carcinoma (HCC) surgery in India:

Type & Complexity of Surgery

• Partial hepatectomy (liver resection) tends to be lower in cost as compared to a full resection or transplant. 
• Transplanting of the liver is much more expensive.
• Complexity and type of surgery (open vs. minimally invasive) also influence the cost-minimally invasive procedures may be more costly because it needs the use of sophisticated equipment and skills. 

City & Hospital Type

• Geography matters a lot.
• Hospital type issues: Privates, multi-specialty hospitals (e.g., Artemis, Medanta, Fortis) tend to be more expensive because of infrastructure, technology and comfort. 

Surgeon’s Expertise & Reputation

• Surgeons of high experience or renowned surgeons are usually more expensive.
• When it comes to a multidisciplinary team, you should expect extra what you pay each specialist. 

Hospital Stay & ICU Charges

• Duration of stay: Short stay after surgery minimizes expenses, and prolonged stay maximizes them. 
• ICU statistics are quite costly. ICU in private hospitals is more expensive.

Diagnostics, Pre-op & Post-op Care

• Pre-operative tests (e.g. imaging, lab panels, biopsy, AFP markers) are more expensive by institution.
• Medications, follow-up imaging/labs, nutritional and rehabilitation care post-op are incurred in addition to the overall price. 

Cancer Stage & Patient Health

• Earlier HCC surgeries (e.g. small tumors, good liver functioning) are not so huge and are less expensive.
• The more severe cases can be accompanied by more extended surgeries, multidisciplinary approaches, and an increased level of complications. 
• Comorbidities or cirrhosis present can increase hospital time or necessitate further interventions, increasing costs. 

Room Category & Personal Preferences

• The bill increases with selection of either private or deluxe rooms, specialized diet plans or customized nursing care.

Advanced hepatocellular carcinoma treatment

The following is a clear summary of treatment of Advanced Hepatocellular Carcinoma (HCC):

What “Advanced HCC” Means?

HCC of the advanced type commonly includes:

• Stage C (BCLC staging system): Large tumors, multiple tumors or tumors that have vascular invasion (portal vein thrombosis) or have metastasized beyond the liver.
• Patients that are not seeking curative surgery or transplant owing to spread of tumor or impaired liver functions.

Treatment Options for Advanced HCC:

Systemic Therapy (First-line Treatment)

The chiefstay of high cases is these:

Targeted Therapy

• Sorafenib -The first oral kinase inhibitor approved.
• Lenvatinib -Alternative first line, tolerated better sometimes.

Immunotherapy

• Atezolizumab + Bevacizumab (Immunotherapy + Anti-angiogenic combo): Atezolizumab is now the standard in combination with Bevacizumab as first-line treatment, provided that the patient has a good liver function and no contraindications (e.g. high bleeding risk).
• Durvalumab + Tremelimumab (STRIDE regimen) - a second first-line.

Second-line Systemic Therapies

Not first-line:

• Regorafenib – after sorafenib progression.
• Cabozantinib – after sorafenib/lenvatinib failure.
• Ramucirumab – for patients with high AFP (>400 ng/mL).
• Nivolumab or Pembrolizumab- checkpoint inhibitors with selected patients.

Locoregional Therapies (Sometimes for bridging/palliation)

Although generally used during intermediate phases, the selected advanced HCC patients can also benefit:

• TACE (Transarterial Chemoembolization): Not generally advised in the case of deep vascular invasion although possibly helpful in the limited spread.
• TARE (Transarterial Radioembolization / SIRT): It can be implemented in the cases of portal vein thrombosis when TACE is not safe.

Radiotherapy

• Stereotactic Body Radiotherapy (SBRT): High precision radiation; useful in patients with limited tumor burden not suitable for TACE/TARE.
• Can also alleviate such symptoms as pain.

Palliative & Supportive Care

• Management of pain, control of the ascites, nutrition are essential.
• Supportive care alone can be most suitable in end-stage disease (liver failure, poor performance status).

Top oncologists for hepatocellular carcinoma in India

• Dr. Tapan Singh Chauhan
• Dr. Arvinder Singh Soin
• Dr. Nitesh Rohatgi
• Dr. Subhash Gupta

Hepatocellular cancer treatment in India with GetWellGo

GetWellGo is regarded as a leading supplier of healthcare services. We help our foreign clients choose the best treatment locations that suit their needs both financially and medically.

We offer:

• Complete transparency
• Fair costs.
• 24 hour availability.
• Medical E-visas
• Online consultation from recognized Indian experts.
• Assistance in selecting India's top hospitals for Hepatocellular cancer treatment.
• Expert oncologists with a strong track record of success
• Assistance during and after the course of treatment.
• Language Support
• Travel and Accommodation Services
• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
• Currency Exchange
• Arranging Patient’s local food